Pregnancy Complications After IVF

Overview 

In vitro fertilisation (IVF) has revolutionised the world of fertility treatment, offering hope to those who face challenges conceiving naturally. IVF has proven to be a miraculous solution for many, with over 1 million babies being born since its introduction.¹ However, like any other medical procedure, IVF comes with potential risks and complications. 

This article explores the complications associated with pregnancy following IVF treatment, such as the increased chances of having twins, triplets or more babies at once. This can lead to problems like premature birth, high blood pressure or issues with your placenta. IVF is also often used by older women, which increases the risk of miscarriage and birth defects. 

It is vital that you are aware of these complications before starting your IVF journey so that you can make informed decisions concerning your pregnancy and seek timely medical help if needed. Although, in some cases, complications cannot be prevented, it is important that you are also aware of what can be done to reduce the risk. Maintaining a healthy lifestyle, regularly attending your prenatal and antenatal checkups and screenings and seeking emotional support throughout your IVF journey can increase the likelihood of a healthy pregnancy.

What is IVF?  

In vitro fertilisation (IVF) is a type of assisted reproductive technology (ART) used to help people with fertility issues to have a baby by combining the egg and the sperm outside of the body.IVF is a multi-step process involving the following steps: 

1. Fertility medications, such as hormone injections, are given to encourage your ovaries to produce multiple eggs at one time.
2. Ultrasound scans are carried out to monitor the development of the eggs, and medicine is given to help the eggs mature.
3. Once the eggs are mature, they are collected via a needle being inserted through your vagina and into your ovaries.
4. The eggs are then mixed with sperm outside the body to allow for fertilisation.
5. 1 or 2 of the strongest embryos (fertilised eggs) are selected and transferred into your uterus (womb).
6. A pregnancy test is carried out 14 days after the embryo transfer to see if the treatment was successful. 

Why is IVF performed? 

People opt for IVF in many different cases, such as if: 

• You are experiencing fertility issues 
• Other fertility treatments have failed 
• One partner has a preexisting health condition 
• There is a history of a genetic condition in the family that can be passed down 
• Infertility due to advanced maternal age (women over age 35) 
• You are a single-sex couple wanting to conceive 
• You wish to conceive without a partner

What factors determine a successful pregnancy with IVF? 

The biggest factor that can impact the likelihood of a successful IVF pregnancy is maternal age. The younger you are, the more likely you are to give birth to a healthy baby through IVF and the less likely you are to experience pregnancy complications. The IVF pregnancy rate of patients aged 18-34 is 41% compared to 6% in patients aged 43-50. This is because fertility potential declines as you get older. 

Healthy lifestyle habits such as maintaining a healthy weight and avoiding smoking, alcohol or caffeine during IVF treatment can also increase your chance of a successful pregnancy.

Other factors such as the cause of your infertility (if it is known), the number of IVF cycles you’ve gone through and whether you have had previous births can all affect your likelihood of having a successful pregnancy.

What complications can occur during the IVF cycle?

The IVF process can be long and emotionally taxing, sometimes requiring multiple rounds of IVF to achieve a pregnancy. It is important to be aware of the complications that can occur during your IVF treatment so that you can seek help if it is needed. 

Complications in egg retrieval 

When retrieving the eggs from the ovaries in the early stages of IVF treatment, the needle that is used could cause bleeding, infection or damage to the bowel, bladder or blood vessels.However, these risks are relatively uncommon, and most procedures are performed without any issues.

Ovarian hyperstimulation syndrome (OHSS) 

Ovarian Hyperstimulation syndrome (OHSS) is a condition that occurs due to an excessive response to fertility medications which are used to mature the eggs in the ovaries. The excessive reaction leads to the ovaries becoming swollen and painful. Previously, the incidence of OHSS was relatively common in women going through fertility treatment (about 10%), but now it occurs in less than 5% of those undergoing IVF.

The signs and symptoms of OHSS depend on the severity of the condition. OHSS can be split into mild and severe OHSS, according to the symptoms. 

Mild OHSS symptoms: 

• Abdominal pain 
• Nausea
• Bloating 
• Slight weight gain

Severe OHSS symptoms: 

• Severe abdominal pain 
• Severe abdominal swelling
• Severe nausea and vomiting 
• Excessive weight gain 
• Difficulty breathing 
• Blood clots 
• Decreased urination 
• Kidney Failure 

If you experience any of these symptoms, contact your healthcare provider immediately. OHSS usually goes away within 2 weeks, and even severe cases have a good outlook if it is treated promptly. Most women can continue with their IVF treatment as normal, but in some severe cases, the embryo transfer may be cancelled or delayed to allow the woman’s body to fully recover. 

Women undergoing IVF should be monitored closely to minimise the risk of complications. Early recognition of risks and swift and appropriate management can lead to a healthier pregnancy.  

What are the complications of IVF after pregnancy?

The IVF process is challenging, and there is a risk of complications occurring during the treatment. It is important to remain mindful of potential pregnancy complications and to be aware that IVF pregnancies are more at risk of certain complications.

Multiple births 

IVF increases the chance of multiple pregnancies, such as having twins, triplets or more.¹

This is because usually, more than one embryo is implanted in your womb during IVF to increase the chances of successful implantation of at least one of the embryos. However, this can also lead to multiple embryos implanting in the womb. Whilst for some, this may seem like a blessing, having multiple pregnancies can increase the likelihood of complications that can harm both the mother and the baby.² It can raise the chance of miscarriage, early birth and low birth weight, with over 50% of twins being born premature and underweight, which can result in health problems and death. Mothers who are pregnant with multiple babies are also more at risk of health problems such as high blood pressure, gestational diabetes or anaemia.¹  

Ectopic pregnancy (or heterotopic) 

Ectopic pregnancy is when the baby starts developing outside the womb, most commonly in the fallopian tube (the tube connecting the ovary to the womb). Unfortunately, when this happens, the baby cannot be moved to the right place and the pregnancy is lost.³ Although any women trying to conceive are at risk of ectopic pregnancy, women who have had IVF treatment are 4 times more likely to experience ectopic pregnancy.³ This is because when the embryo is transferred into the womb, it may travel to the fallopian tube instead. 

If you suspect you are having an ectopic pregnancy, you should get in contact with your healthcare provider immediately. If an ectopic pregnancy is left too long, it can cause the fallopian tube to burst and result in internal bleeding. Symptoms of an ectopic pregnancy include: 

• One-sided lower abdominal pain or shoulder tip pain
• Vaginal bleeding or a dark brown or red discharge 
• Pain or diarrhoea when you go to the toilet

Women who have had IVF are also at increased risk of heterotopic pregnancy, which is when there are multiple pregnancies with one embryo in the womb and one in the fallopian tube. This is normally extremely rare, occurring in roughly 1 in 30,000 pregnancies, but the risk increases to 1 in 100 in women who have had IVF.⁴ Therefore, even if scans show that you are pregnant with a baby growing in your belly, if you are experiencing the symptoms of an ectopic pregnancy, it is important to alert your healthcare provider as you may have a heterotopic pregnancy. 

In the case of a heterotopic pregnancy, the ideal outcome is to end the ectopic pregnancy whilst minimising harm to the mother and the developing baby in the womb. This can be done by surgical intervention or extracting the embryo from the fallopian tube with a needle through the vagina.⁴

Other pregnancy complications associated with IVF

There are other pregnancy complications which are seen more commonly in IVF pregnancies than natural pregnancies. These complications have also been linked to IVF-related factors, such as advanced maternal age, multiple pregnancies and underlying health conditions.¹ 

Gestational diabetes mellitus 

Gestational diabetes mellitus is a type of diabetes that develops during pregnancy and usually disappears after giving birth. Gestational diabetes can cause issues for both the mother and baby during pregnancy, but most women have a normal pregnancy, and the risks are reduced if it is detected early and well-managed. 

Preterm birth and low birth weight

If you are pregnant via IVF, your baby has a slightly higher risk of being born early (preterm birth) or being born underweight compared to babies that are born naturally. Babies that are born early (regardless of whether or not they are born through IVF) are more at risk of complications like lung development issues, intestinal infections, cerebral palsy, language delay and learning and behavioural issues.⁵

Preeclampsia 

Preeclampsia is a serious blood pressure disorder that can arise in pregnancy, usually after 20 weeks of pregnancy. It affects other organs in the mother’s body, and if not treated, it can be life-threatening for both the mother and baby. Preeclampsia is usually diagnosed at antenatal appointments, and once diagnosed, your healthcare provider will closely monitor you and advise you on the best way to treat your preeclampsia. If you are close to your delivery date (37 weeks pregnant or later), your baby will probably be delivered early, and you will most likely be recommended to get a C-section.

Placenta previa 

Placenta previa is when the placenta blocks the cervix (the opening of the womb above the vagina). Normally, the placenta would be away from the cervix to allow the baby to pass through the cervix into the vagina during birth. Placenta previa can lead to complications, like bleeding during pregnancy and delivery, and may require special management or a C-section to ensure the safety of both the mother and the baby.

Maternal age-related risk 

One of the common reasons women opt for IVF is because their fertility declines with age.¹ Whilst IVF has given many women the chance to have a baby that they could not have had naturally, being pregnant at an older age can increase the risk of complications. It is a risk factor for many of the complications listed above but has also been linked to a higher risk of miscarriage and birth defects. There is little difference between IVF pregnancies and natural pregnancies in the risk of miscarriage or birth defects, but increasing maternal age increases the risk.

What can be done to reduce pregnancy complications after IVF? 

Whilst IVF does increase the risk of certain complications in pregnancy, there are methods of reducing this risk, and there is research continuing to be done on how to make IVF pregnancies safer for both the mother and the baby. 

Single embryo transfer (SET) 

Multiple pregnancies are more likely to occur in IVF pregnancies and pose a significant risk to both the mother and the baby.¹ Single embryo transfer is when only one embryo (fertilised egg) is transferred to the mother’s womb, reducing the risk of multiple pregnancies and the complications associated with it. This practice has become much more common in recent years and includes methods like allowing the embryo to develop more before implanting it in the womb, carefully selecting the single best embryo, and freezing some of the embryos for later use instead of implanting them at the same time.

SET is recommended in patients with a good outlook, such as those who are young or in cases where good-quality embryos are available. In other cases, multiple embryo transfers may be used to maintain the likelihood of a successful IVF treatment. Whether or not SET is right for you is something you should discuss with your healthcare provider. 

Screening and prenatal care

Regular screening and good attendance at prenatal care appointments are essential to reduce the risk of complications in IVF pregnancies. Good and regular prenatal care allows for any potential complications to be picked up early, such as gestational diabetes, and treatment to be started as soon as possible, which minimises the risk to both the mother and the baby. 

Lifestyle

Maintaining a healthy lifestyle and following the guidance of your healthcare provider also help ensure the greatest chance for a healthy pregnancy. Keeping a healthy weight and avoiding smoking, alcohol, and caffeine can all reduce the risks of complications in IVF pregnancy.

Education

If you are undergoing IVF, it is important to be aware of the complications that may arise and which symptoms come with them so that you know when to contact your healthcare provider. Being well-informed about the complications of IVF also allows you to make the best decisions for both you and your baby.

Support

IVF can be a long journey and one that is both physically and emotionally challenging, especially if you are faced with complications along the way. Coping with the uncertainties, disappointments and anxieties you may experience during this process is crucial for your overall well-being and mental health. During this time, talking with your close ones or connecting with other people going through a similar experience can help you feel supported and less alone. Your fertility clinic will offer you the opportunity to speak to a counsellor, who you might find useful for support.

Summary 

In conclusion, IVF is undoubtedly a groundbreaking medical achievement, allowing those who cannot conceive naturally to experience parenthood. However, it is important to be mindful of the complications that come with IVF, such as multiple births or premature births, which can lead to health issues for both the mother and baby. Additionally, older women who tend to opt for IVF face a higher risk of complications of miscarriage and birth defects. 

Whilst it is important to be aware of these risks so that complications can be detected earlier on and so you can make well-informed decisions about your pregnancy, it is important to note that there are ways in which you can reduce the risk of complications, such as considering a single embryo transfer. Regular screening and antenatal appointments allow medical professionals to monitor your pregnancy and can help detect complications early. Maintaining a healthy lifestyle and seeking support throughout your pregnancy can be beneficial for both you and your baby’s well-being. 

Despite the challenges, IVF offers renewed hope to those seeking parenthood. With careful consideration, support, and proper medical guidance, individuals can start their IVF journey with confidence, striving for a healthy and successful pregnancy.